End of an Era: The Closing of Tufts Children’s Hospital, Putting Inpatient Pediatric Care in Context

History of Tufts Children’s Hospital 

Previously known as the “Floating Hospital for Children,” Tufts Children’s Hospital began as a ship in the Boston Harbor in 1894. Children were treated by volunteer doctors and nurses as well as the fresh ocean air. In 1920, the floating hospital was brought to land alongside Tufts Medical Center, merging in 1965, and renamed in 2020 as Tufts Children’s Hospital. On January 20, 2022 it was announced that Tufts Children’s Hospital inpatient pediatric beds will be closed and converted to add 41 adult ICU beds, citing increasing demand from critically ill adults. 

While the pediatric inpatient beds are closing, current plans call for continuing to offer a variety of pediatric services, including the adolescent medicine clinic, Center for Children with Special Needs, sub-specialty clinics, Neonatal Intensive Care Unit (NICU), and outpatient surgery. 

What does this mean for patients and staff?

Children currently receiving inpatient care at Tufts Children’s Hospital will be admitted to Boston Children’s Hospital. Previously a competing hospital in the Boston area, this change marks a new relationship between the hospitals. Boston Children’s Hospital is one of the top children’s hospitals in the country, but it differs from Tufts in important ways. It is much larger, with 415 beds compared to 41 beds at Tufts, and focuses more on research. Many families and staff lament the loss of the legacy of Tufts Children’s Hospital and the irreplaceable longitudinal bonds that have formed between patients and providers. Providers are grappling with uncertainty as well, as an estimated 140 doctors and 100 nurses must decide whether to stay under new conditions, or find positions elsewhere. 

The implications of eliminating pediatric inpatient beds but maintaining many other pediatric services are not yet entirely clear. Pediatric specialties that require overnight hospital stays such as cardiology, nephrology, or oncology are likely to dwindle. Additionally, pediatric patients who arrive at Tufts Medical Center emergency department or outpatient care and ultimately require inpatient services will need to be transferred. While Boston Children’s Hospital is not far down the road, this transfer process can feel overwhelming for patients and families, and will also result in increased costs. 

What is the context? 

The closing of the Tufts Children’s Hospital is part of a larger trend. From 2008 to 2018, pediatric inpatient units in the United States decreased by 19.1% and total pediatric inpatient beds decreased by 11.8%. Across the country, rural areas have felt the declines in pediatric hospital beds more acutely, with one quarter of US children experiencing an increased distance to their nearest pediatric inpatient units between 2008 and 2018. These changes are resulting in a broad trend of decreased access to pediatric inpatient care. 

Potentially contributing to this trend is the fact that the pediatric population is less lucrative than the adult population for health care providers. A national study of individuals covered by employer-sponsored health insurance between 2007 and 2010 found that per capita spending on children was lower than per capita spending on the total population at $2,123 vs $4,255, respectively. Additionally, a larger share of total expenditures was out-of-pocket for children’s health care services, which are more likely to go unpaid and lead to losses for hospitals and health care systems. Relatedly, children in Massachusetts and nationwide are more likely to be covered by Medicaid than adults, generating lower reimbursement rates to providers. By age group, spending on children under the age of one far exceeds spending on other age groups, with the majority spent on newborn care and neonatal conditions. Notably, Tufts Medical Center is keeping the NICU. 

Financial Implications of Care Consolidation 

Exacerbated by the COVID-19 pandemic, hospitals and outpatient settings are facing unprecedented financial losses. COVID-19 has simultaneously increased demand for specialized acute care, predominantly in older adults, and imposed unexpected costs, such as for COVID-19 testing. Simultaneously, the pandemic paused elective surgeries and routine office visits, diminishing revenue. Visits to office-based practices fell by 60% during the pandemic, and hospitals suffered significant losses. However, some hospitals fared better than others following the allocation of CARES funding. 

Consolidations of health care systems, both horizontally with larger care systems acquiring smaller practices, and vertically, with insurance companies acquiring physician practices, is nothing new. However, COVID-19 and the associated financial hardships are likely to accelerate this trend, decreasing competition and increasing costs for patients, without improving the quality of care.

Implications for Access

While the closure of Tufts Children’s Hospital will result in care occurring just three miles away, the increased commute and disruption of care relationships may impede access. Concerns about access are multifold. Despite the proximity of Boston Children’s Hospital to Chinatown, there is a fear that this move will leave the community more vulnerable. Historic patterns suggest that Boston Children’s Hospital may not be as generous in the types of insurance they accept and pediatric mental health is experiencing a national emergency, in part due to the COVID-19 pandemic. Thus for certain populations, the Tufts Children’s Hospital closure may be particularly difficult. 

As part of a national trend of declining access to inpatient pediatric care, the closure of Tufts Children’s Hospital is a disheartening loss of legacy, jobs, relationships, and care for the community.